Confronting a problem that affects one out of 10 American couples, this all-inclusive, question-and-answer guide offers insight and encouragement in the face of infertility. Addressing the deep disappointment and emotional distress that accompany a diagnosis, this resource emphasizes that there is still hope regarding this daunting condition. Penned by a reputable endocrinologist who has treated thousands of couples, this helpful reference provides a way to navigate through a confusing time, clearly illustrating the most suitable treatment options. Topics covered include the causes of both female and male infertility, how to cope emotionally with a diagnosis, and utilizing the new Assisted Reproductive Technologies (ART). From choosing a fertility specialist to taking advantage of the most recent developments, this exhaustive study provides practical guidance for couples facing this overwhelming syndrome.
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A Woman's Guide to Pregnancy
By Gerard M. Honoré, Jay S. Nemiro, Jack Kusler
Addicus Books, Inc.Copyright © 2010 Gerard M. Honoré, Ph.D., M.D., and Jay S. Nemiro, M.D.
All rights reserved.
Infertility: An Overview
Not being able to have a baby can be heartbreaking. You no doubt know the frustration. Perhaps you grew up believing that one day you'd be a mother. Now you're not so certain. You're also not alone. It's estimated that as many as 10 percent of reproductive-age females are grappling with infertility, the inability to conceive after one year of unprotected intercourse.
However, just because you haven't conceived doesn't mean you can't. Infertility is a medical problem that can be diagnosed and treated much as any other health issue. Over the past few decades, medical science has made great strides in treating both female and male infertility. So you needn't lose hope. With help, it's quite possible that you can have a baby.
Infertility: A Shared Problem
As a woman, you may feel solely responsible for your inability to conceive. However, infertility is not just a female problem. In fact, nearly 40 to 50 percent of infertility cases involve factors related to the male. In 10 to 35 percent of cases, both the female and the male have a fertility problem. Another 15 to 20 percent of cases are said to be unexplained — meaning doctors don't have a concrete reason for a couple's inability to conceive.
Common Causes of Infertility
In women, the most common causes of infertility involve ovulation factors and a diminishing supply of quality eggs. Most women ovulate normally into their late twenties; however, by age thirty-five to thirty-eight, the ability to ovulate normally may decline. Ovulation may also be affected by factors such as thyroid problems and hormone imbalances. Other major causes of female infertility involve problems with the fallopian tubes, cervix, and/or uterus.
In men, the focus is on the quantity and quality of sperm. Age is not usually a factor in a man's ability to produce sperm; however, any damage to his reproductive organs can cause problems with sperm production and delivery.
In addition, certain lifestyle factors may affect the ability of both sexes to conceive. For example, in women, Chlamydia infections and other sexually transmitted diseases (STDs) can damage the fallopian tubes, resulting in infertility. In men, the use of alcohol, marijuana, and other recreational drugs has well-documented harmful effects on sperm production.
Smoking tobacco may or may not be harmful to reproduction. Some studies show that nicotine and other chemicals from smoking can impair the ovaries and interfere with their ability to create estradiol, the hormone specifically involved in egg production. In fact, some estimates are that tobacco use reduces fertility in both females and males by about 15 percent. Other research, however, shows no evidence of this effect.
Keep in mind that couples aren't tested for infertility simply because they drink alcohol or smoke. They're screened for infertility because they've been unsuccessful in their pregnancy attempts. Previous behaviors may come up in the evaluation, but there are likely other reasons for the problem.
Types of Infertility
Couples who have never conceived are said to have primary infertility. Couples who are unable to conceive even though they've had a child previously have secondary infertility. In fact, infertility sometimes first surfaces when a couple attempts to have a second child. In many cases, however, couples experience both primary and secondary infertility.
Treatment for Infertility
Thanks to modern technology, help is available for couples having difficulty conceiving. The treatments, described later in this book, range from fertility drugs that can help the ovaries release eggs to microsurgery that can repair physical problems in both women and men. The biggest treatment breakthrough in reproductive technology during the past thirty years has been in vitro fertilization (IVF), a procedure in which fertilization occurs outside the body when an egg and sperm are joined in a laboratory; the embryo is then implanted in the woman's uterus.
Costs for Treatment
The costs linked to fertility treatment can vary greatly, depending on the procedures you have done, where you live, and which doctor you see. Treatment costs can run into tens of thousands of dollars if you and your partner must undergo high-tech procedures, use donor eggs, or engage a gestational carrier.
Does Insurance Pay?
Although infertility is considered a disease, insurance coverage for fertility treatment is mandated in fewer than fifteen states. That means there's a good chance you'll be paying out-of-pocket for most of your treatment.
Even if your insurer offers coverage, there's wide variance in which services are covered. For example, an IVF procedure may be specifically excluded, or it may be included only if you use your own eggs and your partner's sperm. In other cases, your policy might require that you have a specific history of infertility resulting from a condition considered to be a general health problem, such as endometriosis or fibroid tumors. In addition, your policy might require that you be under a certain age, or it may have a lifetime limit covering a maximum number of treatment cycles for each covered procedure.
If you see a fertility specialist, someone in his or her office will discuss costs and your insurance coverage with you. It's important to understand the costs early on, so that you don't encounter additional stress due to unexpected financial obligations.CHAPTER 2
Not being able to get pregnant when you want a child can be a painful and isolating experience. As you worry about whether you'll ever become a mother, it may seem as if women all around you are having babies. You may feel that most people don't understand what you're going through emotionally — your longing to be pregnant, to experience childbirth, and to bond with an infant. Indeed, it hurts deeply, and the despair can take a toll on your self-esteem. So how do you overcome the disappointment and navigate the frustrations? By marshaling your inner reserve and gaining support from your partner and others around you, you can cope with infertility.
Understand the Challenges
To cope emotionally — and to keep your relationship with your partner intact — it's important that you understand the emotional challenges ahead of you. Not surprisingly, infertility evokes many of the same feelings that people experience with the death of a loved one — denial ... anger ... guilt ... blame ... depression ... and acceptance. Of course, mourning your hopes and dreams is different from mourning the loss of a loved one; nonetheless, the emotions can be quite similar.
Many couples try to get pregnant on their own for years before they finally seek help. Filled with hope, they keep trying, believing that they'll eventually conceive. However, denying that a problem may exist only serves to intensify your disappointment and delay potentially helpful treatment.
Being angry is a normal emotional response to infertility. It is simply an outward sign of frustration over not being in control of events and the emotions those events evoke. The more you understand your anger, the more likely you are to express it in an appropriate manner — and not in ways that are destructive to you or the people around you.
Guilt and Blame
When you're searching for answers, it's natural to wonder if you did something in the past to cause your infertility. But dwelling on the past can sap your energy and prevent you from moving forward. If the blame is directed toward your partner, it can lead to a breakdown in your relationship at a time when you need each other the most.
When you grieve, it's also normal to become depressed. However, with time and emotional support, you can bounce back. But if you exhibit any signs of severe or clinical depression — apathy, intense anxiety, fatigue, poor concentration, or the inability to make decisions — you may need professional help. Fortunately, many counselors specialize in infertility counseling. Antidepressants can also help lift depression.
Gather Your Coping Skills
Seeking help for your infertility is usually a sign that you've accepted the fact that something is wrong and you need to find answers. It's a positive first step. That doesn't mean that you won't experience disappointment or doubt as you're being evaluated and treated. You may face multiple procedures before you experience success, and you'll likely still wonder at times if you'll ever conceive or carry a baby to full term. But hearing that your infertility actually has a medical cause — and, more than likely, some treatment options — will alleviate much of your distress. What else can you do? No matter where you are in the fertility treatment process, there are simple steps you can take to stay focused, energized, and emotionally healthy.
Understanding your problem — and leaving the guesswork behind — is essential to coping. Being informed will help you to understand the medical tests and treatments being recommended, allowing you to weigh the risks against the rewards. The more you learn, the more empowered you'll feel.
Keep Your Options Open
You'll probably have a very clear idea of your goals when you begin the fertility treatment process. But as realities change, you may need to reassess your options. What once seemed like an unacceptable choice may become the preferable alternative. Your doctor will likely outline the treatment alternatives in the beginning, focusing on the best probability for success. Then, if a therapy doesn't work in a reasonable amount of time, you'll need to decide on the next step. Try to stay flexible.
Manage Your Stress
No matter how hard you try, it's unlikely that you can eliminate all your anxieties about your infertility and the treatment process. It's not uncommon to feel apprehension, nervousness, and even panic, but there are things you can do to manage those feelings.
Eat right, exercise daily, and get sufficient sleep. A nutritious diet and a good exercise program can empower you physically and emotionally. Sleep loss is emotionally debilitating, so get plenty of rest.
Join a support group. Communicating with others who are grappling with infertility can be most helpful. Participating in a support group can ease the sense of isolation and help lift depression. Organizations such as RESOLVE, the National Infertility Association (www.resolve.org), host support groups throughout the country. Your fertility clinic may also sponsor group sessions.
Keep a "gratitude" journal. Journaling is an effective way to express your emotions and chronicle your progress. Some women find it helpful to journal affirmations to themselves — positive things in the midst of the tension and anxiety.
Practice meditation and yoga. By channeling your thoughts and disciplining your body, you can relieve stress.
Keep Your Infertility in Perspective
It's easy to let "having a baby" become the focus of your entire life. But try to avoid letting it dominate your conversations or, for that matter, your daily life. Maintaining a normal routine during fertility treatment may seem challenging at times. Couples often plan their activities around their infertility procedures. Or they avoid situations that remind them that they don't have the family they want. But allowing your infertility to dominate your thinking isolates you emotionally. Instead, try to do things you'd usually do and see people you'd normally see.
Get Support from Your Partner
When it comes to emotional support, you need it first from your partner. But since infertility evokes so many passions and expectations, your mate may not always give you what you need. Your partner may want to be loyal, caring, and sympathetic, but may say and do the "wrong" things. How do you get the support you need? There are steps you can take to ensure that you feel supported by your partner and that your relationship survives the infertility experience.
Understand Your Partner's Anxieties
As a woman, you're dealing with your own particular anxieties — but remember, your partner is likely dealing with many of his own. On the one hand, he may be concerned for you if you're the one undergoing the tests and procedures. He may feel like a helpless bystander. On the other hand, he may be stressed by his own role, especially if his sperm is deemed inadequate. No matter how much you reassure him that his sperm count is not a measure of his manhood, he may feel guilty and ashamed. Men often believe that their masculinity is diminished if their partner can't get pregnant.
In addition, you and your partner may have entirely different coping mechanisms. Your partner's silence may mask his pain, while you may feel relieved when you express your emotions. By understanding your differences and making allowances for them, you'll improve your communication.
Ask for What You Need
As close as you and your partner may be, you can't expect him to read your mind. Even in the best relationships, people need to make clear what they need. Many times, you may simply need to have your partner listen to you and acknowledge that he understands what you're going through.
You may feel supported by having your partner attend fertility evaluations and treatments with you. If so, ask him to attend as many appointments as possible. (Many men don't attend if they're not asked.) By being actively involved in the process, your partner will learn more and will likely be more understanding of what you're going through.
Protect Your Relationship
Failing to conceive is often the first crisis a couple faces together. And the fertility treatment process — particularly if it's long, complicated, or painful — can add to the strain. The good news is that most couples survive; some even become stronger. Unfortunately, for others, the stress ultimately ends the relationship. Perhaps one partner wants children more than the other partner does. The difference may not be immediately apparent, but if the stress builds, it can produce a flash point. One partner may demand an end to the treatment, while the other wants to continue.
Of course, if you and your partner disagree on the fundamentals of your relationship, you may have issues beyond just having a baby. But if the problems you're experiencing with infertility involve a lack of communication or mounting stress, you can find ways to overcome those issues. For instance, by scheduling time each day to discuss infertility issues, you allow yourselves the opportunity to express your feelings and concerns, but free up the remaining hours to talk about other things. It's important that you be honest with each other and focus on understanding what each of you is feeling.
Many couples complain that their sex life is no longer spontaneous or enjoyable because it has become centered on conception. Other factors may also affect sexual intimacy during fertility treatment. For example, some medications and procedures increase the size of a woman's ovaries, making intercourse physically uncomfortable for her. At some points in treatment, a couple may even be asked to avoid sex completely.
It's important to realize that your sex life will be spontaneous and enjoyable again. In the meantime, by taking advantage of the quality time you do have together and finding ways to cement your relationship beyond sexual intimacy, you can actually enrich your relationship. Remember that you were a loving couple before you wanted to be parents. Perhaps it's time to rekindle that spark that first brought you together.
Get Support from Your Family and Friends
Telling other people about your infertility can be stressful. For most couples, infertility is a very private and emotionally charged topic. It can be even more painful to discuss if you sense that others don't understand what you're feeling. Perhaps you'll choose to keep such personal information to yourself. Yet bringing others into your confidence and asking for their support can be a healthy step in coping with infertility.
Excerpted from Overcoming Infertility by Gerard M. Honoré, Jay S. Nemiro, Jack Kusler. Copyright © 2010 Gerard M. Honoré, Ph.D., M.D., and Jay S. Nemiro, M.D.. Excerpted by permission of Addicus Books, Inc..
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Table of Contents
1 Infertility: An Overview 1
2 Coping Emotionally 4
3 Female Infertility 12
4 Getting a Diagnosis 26
5 Treatment with Fertility Drugs 42
6 Fertility Treatment Procedures 49
7 Reproductive Surgery 68
8 Male Infertility 72
9 Treatment for Male Infertility 87
10 Donor Sperm 92
11 Donor Eggs and Embryos 98
12 Gestational Carriers 105
About the Authors 141